Wei D M, Li W M, Qian Y, Cao S D, Liu D Y, Pan X L, Lei D P
Department of Otorhinolaryngology, Qilu Hospital of Shandong University, National Health Commission Key Laboratory of Otorhinolaryngology (Shandong University), Jinan 250012, China.
Department of Otorhinolaryngology, Qilu Hospital of Shandong University, National Health Commission Key Laboratory of Otorhinolaryngology (Shandong University), Jinan 250012, China; Department of Otorhinolaryngology Head and Neck Surgery, Qilu Hospital of Shandong University (Qingdao), Qingdao 266100, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2020 Dec 7;55(12):1120-1125. doi: 10.3760/cma.j.cn115330-20200626-00528.
To evaluate the oncologic and functional outcomes of postcricoid carcinoma treated by surgical treatment, and to summarize our clinical experience in surgical treatment and reconstructive techniques. Medical files of 45 patients were collected and retrospectively analyzed. The patients received surgical treatments between January 2010 and May 2017 in the Qilu Hospital of Shandong University, including 39 males and 6 females, the age ranged from 41 to 78 years old. T1, T2, T3 and T4 staging tumors represented respectively for 2,13,23 and 7 cases. And cervical metastasis was histologically identified in 33 cases (8 for N1 and 25 for N2). Advanced staging patients (10 in Stage Ⅲ and 30 in Stage Ⅳ) accounted for 88.9% of the cohort, while early staging cases (1 in Stage Ⅰand 4 in Stage Ⅱ) for 10.1%. All patients received cervical lymph node dissection. After tumor excision without compromising margins, hypopharyngeal functions were reconstructed by residual mucosa, pectoralis major myocutaneous flap, laryngotracheal tissue flap or gastric tissue flap, and laryngeal functions were reconstructed by epiglottis, sternohyoid myofascial flap or thyroid perichondrium. Survival rates were analyzed by the Kaplan-Meier method. Postoperatively 23 patients received radiotherapy and 13 patients received chemoradiotherapy. All patients were followed up for more than 3 years. Total 3-year and 5-year survival rates were 60.5% and 49.0%, respectively. Patients obtaining the conservation of laryngeal functions accounted for 44% (20/45) of all cases. The neck lymph node positive rate was 73.3%(33/45), and log-rank test demonstrated that cervical lymph node metastasis was significantly associated with prognosis of patients (χ(2)=4.364, =0.037). Appropriate surgical approaches and excision methods and comprehensive application of flaps are critical to precise tumor excision and reconstruction of laryngeal functions, thereby improving the quality of life of patients with posterior carcinoma.
评估环状软骨后癌手术治疗的肿瘤学和功能结局，并总结我们在手术治疗及重建技术方面的临床经验。收集并回顾性分析45例患者的病历资料。这些患者于2010年1月至2017年5月在山东大学齐鲁医院接受手术治疗，其中男性39例，女性6例，年龄范围为41至78岁。T1、T2、T3和T4分期的肿瘤分别为2例、13例、23例和7例。经组织学检查发现33例有颈部转移（N1为8例，N2为25例）。晚期分期患者（Ⅲ期10例，Ⅳ期30例）占该队列的88.9%，而早期分期病例（Ⅰ期1例，Ⅱ期4例）占10.1%。所有患者均接受了颈部淋巴结清扫术。在确保切缘阴性的肿瘤切除术后，下咽功能通过残余黏膜、胸大肌肌皮瓣、喉气管组织瓣或胃组织瓣进行重建，喉功能通过会厌、胸骨舌骨肌筋膜瓣或甲状腺软骨膜进行重建。采用Kaplan-Meier法分析生存率。术后23例患者接受了放疗，13例患者接受了放化疗。所有患者均随访3年以上。3年和5年总生存率分别为60.5%和49.0%。保留喉功能的患者占所有病例的44%（20/45）。颈部淋巴结阳性率为73.3%（33/45），对数秩检验表明颈部淋巴结转移与患者预后显著相关（χ(2)=4.364，P=0.037）。合适的手术入路和切除方法以及皮瓣的综合应用对于精确切除肿瘤和重建喉功能至关重要，从而提高环状软骨后癌患者的生活质量。
